Bilateral Hypoglossal Nerve Palsy After Thyroidectomy: A Case Report

Surgical resection remains the primary treatment modality for well-differentiated thyroid carcinoma. However, hypoglossal nerve injury following thyroidectomy represents a rare complication. We report a case of bilateral hypoglossal nerve palsy in a 57-year-old female patient who underwent bilateral total thyroidectomy with neck dissection and thyroglossal duct cyst excision under general anesthesia. Comprehensive imaging and electrophysiological studies confirmed bilateral hypoglossal nerve dysfunction, although surgical re-exploration revealed anatomically intact nerves. Despite empirical steroid treatment, neurological improvement was limited. The patient subsequently underwent intensive, multidisciplinary neurorehabilitation. Over the following months, swallowing function gradually improved, allowing a return to oral intake, although mild dysarthria persisted. This case presents a complex and rare neurological complication following thyroid surgery. Although thyroidectomy techniques are well-established, preoperative assessment should carefully consider the potential risk factors for hypoglossal nerve injury to optimize surgical outcomes.